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High Resilience Linked to High PrEP Use Among Canadian MSM


The study also showed, despite an existing association between discrimination based on sexual orientation and HIV pre-exposure prophylaxis (PrEP) use, increased resilience reduced the effects of such discrimination on PrEP use.

Canadian men who have sex with men (MSM) who are eligible for HIV pre-exposure prophylaxis (PrEP) and had higher resilience scores were also more likely to have used PrEP in the past 6 months, according to a study published today in AIDS and Behavior.

The study included sexually active MSM 16 years and older, recruited via respondent-driven sampling (RDS) in Toronto, Montreal, and Vancouver between February 2017 and July 2019.

Researchers conducted a pooled cross-sectional analysis of MSM who either were not living with HIV or whose sero status was unknown who met clinical eligibility for PrEP. Of 1167 PrEP-eligible MSM without HIV, 317 (27%) said they had taken PrEP in the past 6 months.

The researchers also performed multivariable RDS-II–weighted logistic regression to evaluate the association between Connor-Davidson Resilience-2 Scale scores and PrEP use, and used mediation analyses with weighted logistic and linear regression to determine whether the relationship between minority stressors and PrEP use was mediated by resilience.

For this study, the authors defined resilience as “thriving despite adversity.”

“Multiple qualitative and quantitative studies highlight resilience among sexual minority individuals as buffering the negative impact of prejudice and, in turn, promoting positive health outcomes,” the authors said. “While previous research has identified associations between resilience and good mental health, there is limited research that applies a strengths-based resilience approach to understanding the risks of HIV transmission among GBM [gay, bisexual, and other MSM].”

The multivariable model demonstrated an association between higher resilience score and greater odds of PrEP use in the past 6 months (adjusted odds ratio [aOR], 1.13; 95% CI, 1.00-1.28).

Although other research has shown an association between discrimination based on sexual orientation and PrEP use, the authors of this study said increased resilience reduced the effects of such discrimination on PrEP use (aOR, 1.54; 95% CI, 1.19-1.98).

Higher scores of sexual orientation acceptance concern were positively associated with PrEP use in the past 6 months (aOR, 1.19, 95% CI, 1.01-1.41), while higher scores of internalized homophobia were negatively associated with PrEP use (aOR, 0.71; 95% CI, 0.57-0.89).

When resilience was factored in, it had a mediating effect on the association between sexual orientation acceptance concern and PrEP use with −0.0157 (95% CI, -0.032 to -0.003), and mediated 8.6% of the relationship between internalized homonegativity and PrEP use with −0.011 (95% CI, -0.024 to -0.001).

“These findings demonstrate a need for increased outreach on PrEP education, increased offering of PrEP at no cost, and improved communication on the manageability of PrEP side effects,” the authors said. “The processes GBM must undertake to obtain PrEP entails several potential individual, interpersonal, and structural barriers which must also be addressed.”

Finally, the authors cited another study that found reducing wait times to see PrEP providers, public discussions on PrEP, improved PrEP guidelines, additional resources on PrEP, and information on how to find PrEP providers were among the top factors that may influence PrEP use.


Sang JM, Wang L, Moore DM, et al. Examining associations between resilience and PrEP use among HIV-negative GBM in Toronto, Montreal and Vancouver. AIDS Behav. Published online March 3, 2023. doi:10.1007/s10461-023-04031-1

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